Transcription of Electronic Funds Transfer (EFT) & Electronic Remittance ...
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Electronic Funds Transfer (EFT) & Electronic Remittance ...
Electronic Funds Transfer (EFT) & Electronic Remittance Advice (ERA) Enrollment Package Dear TriWest Network Provider, Thank you for your interest in Electronic Funds Transfer (EFT) and/or Electronic Remittance Advice (ERA) with PGBA, LLC. PGBA is pleased to partner with TriWest Healthcare Alliance to administer claims processing for the Department of Veterans Affairs (VA) Community Care Network. Enclosed are the EFT and ERA enrollment forms along with instructions for completion. These forms can also be used to indicate a change or cancellation to a current enrollment. Please take the time to review this package thoroughly and follow the instructions and requirements.
check/EFT numbers received within the last 30 days, choose the new enrollment reason. If you must change or cancel your current PGBA EFT enrollment, choose the appropriate reason and include the previous routing & account numbers used for receiving EFT payments. You must submit a completed EFT application with the
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